Impact of Laughter Therapy on Anxiety and Pain in Pediatric Dentistry: A Double-Blinded Randomized, Controlled Clinical Trial

Authors

  • Fatemeh Jahanimoghadam
  • Raziyeh Shojaeepoor
  • Reyhaneh Aftabi
  • Arash Shahravan
  • Azadeh Horri
  • Sima Jookar

Keywords:

Pediatric Dentistry, Dental Anxiety, Laughter therapy

Abstract

Objective: To evaluate the effect of laughter therapy on reducing anxiety and pain during dental procedures in children 5‒7 years of age. Material and Methods: 48 children aged 5‒7 years were included in this cross-over double-blinded clinical trial after the parents completed the Screen for Child Anxiety Related Disorder questionnaire (SCARED). After allocation into two groups: laughter intervention (A) and neutral intervention (B), the anxiety as well as pain were determined by Modified Child Dental Anxiety Scale Faces questionnaire (MCDASF) and the Wong-Baker Faces Scale, respectively. Also, the child’s behavior during the treatment was recorded using the Sound, Eye, Motor scale (SEM). Data were analyzed by SPSS 21 using Paired t-test, Independent t-test, Chi-square, Mann-Whitney and Wilcoxon’s test. Results: The mean score of anxiety in the laughter intervention group (17.42±2.74) was significantly less than (22.06±2.16) in the neutral intervention group (p=0.000) and lower in boys in both groups (p=0.000, p=0.047). The mean pain severity reported by the children in the neutral intervention group (5.33±1.81) was higher than in the laughter intervention group (2.38±1.87; p=0.00) and higher in girls in both groups (p=0.02; p=0.03). Conclusion: The laughter intervention before dental procedures had a significant effect on reducing anxiety and pain during dental treatment.

References

Bradt J, Teague A. Music interventions for dental anxiety. Oral Dis 2018; 24(3):300-6. https://doi.org/10.1111/odi.12615

Aitken JC, Wilson S, Coury D, Moursi A. The effect of music distraction on pain, anxiety and behavior in pediatric dental patients. Pediatr Dent 2002; 24(2):114-8.

Asl Aminabadi N, Erfanparast L, Sohrabi A, Ghertasi Oskouei S, Naghili A. The impact of virtual reality distraction on pain and anxiety during dental treatment in 4-6 year-old children: a randomized controlled clinical trial. J Dent Res Dent Clin Dent Prospects 2012; 6(4):117-24. https://doi.org/10.5681/joddd.2012.025

Prabhaker AR, Marwah N, Raju OS. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. J Indian Soc Pedod Prev Dent 2007; 25:177-82.

Ram D, Peretz B. Administering Local anaesthesia to paediatric dental patients – current status and prospects for the future. Int J Paediatr Dent 2002; 12(2):80-9. https://doi.org/10.1046/j.1365-263x.2002.00343.x

Carr KR, Wilson S, Nimer S, Thornton JB Jr. Behavior management techniques among pediatric dentists practicing in the southeastern United States. Pediatr Dent 1999; 21(6):347–53.

Oredugba FA, Sanu OO. Behavior management techniques employed by Nigerian dentists for their child patients. Pesqui Bras Odontopediatria Clin Integr 2009; 9:271-6. https://doi.org/10.4034/1519.0501.2009.0093.0004

Brain M. How laughter works. How Stuff Works. 2000. Available from: http://science.howstuffworks.com/life/inside-the-mind/emotions/laughter.htm [Accessed on July 13, 2020].

Sakuragi S, Sugiyama Y, Takeuchi K. Effects of laughing and weeping on mood and heart rate variability. J Physiol Anthropol Appl Human Sci 2002; 21(3):159-65. https://doi.org/10.2114/jpa.21.159

Demir M. Effects of laughter therapy on anxiety, stress, depression and quality of life in cancer patients. J Cancer Sci Ther 2015; 7(9):272-3. https://doi.org/10.4172/1948-5956.1000362

Butler B. Laughter: the best medicine? OLA Quarterly 2014; 11(1):11-13. https://doi.org/10.7710/1093-7374.1074

Vagnoli L, Caprilli S, Robiglio A, Messeri A. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics 2005; 116(4):e563-7. https://doi.org/10.1542/peds.2005-0466

Felluga M, Rabach I, Minute M, Montico M, Giorgi R, Lonciari I, et al. A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department. Eur J Pediatr 2016; 175(5):645-50. https://doi.org/10.1007/s00431-015-2688-0

Weisenberg M, Raz T, Hener T. The influence of film-induced mood on pain perception. Pain 1998; 76(3):365-75. https://doi.org/10.1016/S0304-3959(98)00069-4

Alcântara PL, Wogel AZ, Rossi MI, Neves IR, Sabates AL, Puggina AC. Effect of interaction with clowns on vital signs and non-verbal communication of hospitalized children. Rev Paul Pediatr 2016; 34(4):432-8. https://doi.org/10.1016/j.rppede.2016.02.011

Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. Int J Surg 2010; 10(1):28-55. https://doi.org/10.1016/j.ijsu.2011.10.001

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39(2):175-91. https://doi.org/10.3758/bf03193146

Aminabadi NA, Vafaei A, Erfanparast L, Oskouei SG, Jamali Z. Impact of pictorial story on pain perception, situational anxiety and behavior in children: a cognitive-behavioral schema. J Clin Pediatr Dent 2011; 36(2):127-32. https://doi.org/10.17796/jcpd.36.2.3163251527508338

Javadinejad S, Farajzadegan Z, Madahain M. Iranian version of a face version of the modified child dental anxiety scale: Transcultural adaptation and reliability analysis. J Res Med Sci 2011; 16(7):872-7.

Fox C, Newton J. A controlled trial of the impact of exposureto positive images of dentistry on anticipatory dental fear in children. Community Dent Oral Epidemiol 2006; 34(6):455-9. https://doi.org/10.1111/j.1600-0528.2006.00303.x

Al-Khotani A, Bello LA, Christidis N. Effects of audiovisual distraction on children's behaviour during dental treatment: a randomized controlled clinical trial. Acta Odontol Scand 2016; 74(6):494-501. https://doi.org/10.1080/00016357.2016.1206211

Rao DG, Havale R, Nagaraj M, Karobari NM, Latha AM, Tharay N, et al. Assessment of efficacy of virtual reality distraction in reducing pain perception and anxiety in children aged 6-10 years: a behavioral interventional study. Int J Clin Pediatr Dent 2019; 12(6):510-13. https://doi.org/10.5005/jp-journals-10005-1694

Rajeswari SR, Chandrasekhar R, Vinay C, Uloopi KS, RojaRamya KS, Ramesh MV. Effectiveness of cognitive behavioral play therapy and audiovisual distraction for management of preoperative anxiety in children. Int J Clin Pediatr Dent 2019; 12(5):419-22. https://doi.org/10.5005/jp-journals-10005-1661

Sekhavatpour Z, Khanjani N, Reyhani T, Ghaffari S, Dastoorpoor M. The effect of storytelling on anxiety and behavioral disorders in children undergoing surgery: a randomized controlled trial. Pediatric Health Med Ther 2019; 10:61-8. https://doi.org/10.2147/PHMT.S201653

Ramos-Jorge ML, Ramos-Jorge J, Vieira de Andrade RG, Marques LS. Impact of exposure to positive images on dental anxiety among children: a controlled trial. Eur Arch Paediatr Dent 2011; 12(4):195-9. https://doi.org/10.1007/BF03262806

Koticha P, Katge F, Shetty S, Patil DP. Effectiveness of virtual reality eyeglasses as a distraction aid to reduce anxiety among 6-10-year-old children undergoing dental extraction procedure. Int J Clin Pediatr Dent 2019; 12(4):297-302. https://doi.org/10.5005/jp-journals-10005-1640

Abolghasemi A, Hajjaran M, Kiamarsi A. The effectiveness of cognitive-behavioral interventions in reduction of distress resulting from dentistry procedures in children. J Dent Tehran Univ Med Sci 2007; 20(2):150-5.

Kilinç G, Akay A, Eden E, Sevinç N, Ellidokuz H. Evaluation of children's dental anxiety levels at a kindergarten and at a dental clinic. Braz Oral Res 2016; 30(1):1-8. https://doi.org/10.1590/1807-3107BOR-2016.vol30.0072

Oliveira MM, Colares V. The relationship between dental anxiety and dental pain in children aged 18 to 59 months: a study in Recife, Pernambuco State, Brazil. Cad Saude Publica 2009; 25(4):743-50. https://doi.org/10.1590/S0102-311X2009000400005

Towsend JA. Behavior Guidance of the Pediatric. In: Pinkham JR, Casa Massimo PS, editors. Pediatric Dentistry-Infancy Through Adolescence. 5 th. ed. Philadelphia: Elsevier Saunders; 2013. 355p.

McGrath PJ, Beyer J, Cleeland C, Eland J, McGrath PA, Portenoy R. Report of the subcommittee on assessment and methodologic issues in the management of pain in childhood cancer. Pediatrics 1990; 6(5):814-7.

Rhudy JL, Meagher MW. Fear and anxiety: divergent effects on human pain thresholds. Pain 2000; 84(1):65-75. https://doi.org/10.1016/S0304-3959(99)00183-9

Bronzo A, Powers G. Relationship of anxiety with pain threshold. J Psychol 1967; 66(2):181-3. https://doi.org/10.1080/00223980.1967.10544893

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Published

2022-11-30

How to Cite

Jahanimoghadam, F., Shojaeepoor, R., Aftabi, R., Shahravan, A., Horri, A., & Jookar, S. (2022). Impact of Laughter Therapy on Anxiety and Pain in Pediatric Dentistry: A Double-Blinded Randomized, Controlled Clinical Trial. Pesquisa Brasileira Em Odontopediatria E Clínica Integrada, 22, e210160. Retrieved from https://revista.uepb.edu.br/PBOCI/article/view/1604

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Original Articles